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1. Mass media has been both beneficial and hurtful to healthcare by spreading both accurate and inaccurate information regarding vaccines. How can healthcare informatics aid in the improvement of patient trust, education, and compliance?

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2. Compare and contrast the project management strategies, organizational resources, and team member roles needed for a workflow redesign project that can be implemented within one department to a project that requires an enterprise-level change.

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(Centers for Disease Control and Prevention, 2024)

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The best way to prevent hepatitis B is by getting vaccinated.

Infants, children, and adults can get vaccinated for hepatitis B.

Hepatitis B vaccine is safe and effective.

Talk to your doctor about getting vaccinated for hepatitis B.

Recommendations at a glance

CDC recommends hepatitis B vaccine for:

All infants.

All children and adolescents younger than 19 who have not been vaccinated.

Adults 19-59.

Adults 60 and older with risk factors for hepatitis B.

Why vaccination is important

Getting vaccinated is the best way to prevent hepatitis B infection.

Hepatitis B vaccine dosing

Hepatitis B vaccine is a series of two or three shots depending on the vaccine brand.

Missing a dose

If you miss a dose of hepatitis B vaccine, it's okay. Be sure to get the next dose as soon as possible.

Pregnancy considerations

Hepatitis B vaccine is safe for pregnant people. Talk to your doctor about the best option for you.

Boosters are often not necessary

A "booster" dose is an extra dose of vaccine that can increase or extend the effectiveness of the vaccine. Most healthy people do not need a booster dose.

What to expect

If you get the three-shot series, your doctor will give them over a 6-month period. If you get the vaccine that is two doses, you will get them about one month apart. You need to get all of the shots to be fully protected.

Safety and effectiveness

Hepatitis B vaccine is safe and effective. It gives you long-term protection against illness from acute and chronic infection.

Possible side effects

Hepatitis B vaccine is safe, and most people don't experience any side effects. Soreness at the injection site is the most common side effect.

Available vaccines

There are several types of hepatitis B vaccines available in the United States. Talk to your doctor to determine which vaccine is right for you.

Where to get the vaccine

Hepatitis B vaccine is available now. Talk to your doctor to get vaccinated.

Resources

Immunize.org has several helpful resources for parents that help outline vaccination details for their children.

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Learn about hepatitis B vaccination, safety, who should receive it, and where to get vaccinated.

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Ask the Experts: Which Adults Need HepB Vaccine?

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Updated (2022) CDC Recommendations for Hep B Vaccines for Adults 

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Updated (2022) CDC Recommendations for Hep B Vaccines for Adults 

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Enhancing Hepatitis A and B Vaccinations Through Electronic Clinical Decision Support Systems and Staff Education in a Correctional Facility

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Enhancing Hepatitis A and B Vaccinations Through Electronic Clinical Decision Support Systems and Staff Education in a Correctional Facility

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In this article, Atem and El Ghaziri (2023) describe the results of a quality improvement project to evaluate clinical decision support systems and staff education in a correctional setting on hepatitis A and B vaccination rates and staff knowledge.

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Atem et al. 2023_Enhancing Hepatitis A and B Vaccinations

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Implementing Health System Improvement: Resources and Strategies for Interprofessional Teams

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Implementing Health System Improvement: Resources and Strategies for Interprofessional Teams

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Eljiz and colleagues (2023) discuss the continuum and parts of health systems improvement and offer a six-step process to help interprofessional healthcare teams improve care outcomes by collaboratively creating and sharing knowledge.

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Elijiz et al. 2023_Implementing health system improvement

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Implementing Adult Hepatitis B Immunization and Screening Using Electronic Health Records: A Practical Guide

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Implementing Adult Hepatitis B Immunization and Screening Using Electronic Health Records: A Practical Guide

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The Centers for Disease Control and Prevention (CDC) issued updated adult hepatitis B vaccination recommendations in 2022. Kim and colleagues (2024) provide information about hepatitis B screening and vaccination for clinicians and suggest a framework health systems can use to create electronic health record strategies to address the new recommendations.

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Kim et al. 2024_Implementing adult hepatitis B immunization

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Adult Immunization Against Hepatitis B: Does the Number of Jabs Matter?

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Adult Immunization Against Hepatitis B: Does the Number of Jabs Matter?

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In this article, Oster and colleagues (2022) used decision-analytic modeling to compare expected hepatitis B vaccination adherence and seroprotection among adults beginning the vaccination series with either the three-dose ENGERIX-B or the two-dose HEPLISAV-B product.

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Oster et al. 2022_Adult immunization against hepatitis B_Does number of jabs matter

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A New Validated Approach for Identifying Childhood Immunizations in Electronic Health Records in the United Kingdom

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A New Validated Approach for Identifying Childhood Immunizations in Electronic Health Records in the United Kingdom

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Suffel and colleagues (2024) addressed the issue of ambiguous coding of vaccination timing and status in EHRs by proposing an algorithm for identifying childhood immunizations that are regularly documented. They were able to generate vaccine coverage estimates that were comparable to national estimates and suggested their method may be useful for researchers and policymakers.

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Suffel et al. 2024_A New Validated Approach

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Successful Management of IT Projects in Healthcare Institutions after COVID-19: Role of Digital Orientation and Innovation Adaption

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Successful Management of IT Projects in Healthcare Institutions after COVID-19: Role of Digital Orientation and Innovation Adaption

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In this article, Tucmeanu and colleagues (2022) examined the mediating effect of innovation adaptation on the relationship between digital orientation and successful management of information technology (IT).

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Tucmeanu et al. 2022_Successful management of IT projects

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(World Health Organization Regional Office for the Western Pacific, 2018)

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World Health Organization Regional Office for the Western Pacific

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Hepatitis B Vaccine - A Power Tool to fight the disease

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Chronic hepatitis B is far more prevalent among U.S. residents than previously reported » Hepatitis B Foundation

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A new study says about 2.4 million U.S. residents may be infected with the disease.

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This project will improve the hepatitis B vaccine administration process for adult patients in a primary care clinic.

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A primary care clinic located in the southeastern area of the US uses EHR-based tools embedded in EPIC when administering and documenting hepatitis B vaccinations for patients. Clinic staff recently identified inconsistencies and ambiguities regarding the way hepatitis B vaccine products are named within the immunization tab of the EHR. This makes it difficult for providers to accurately identify and document the intended vaccine and may lead to errors. The aim of this workflow redesign project is to identify and address these inconsistencies and ambiguities with the goal of reducing vaccination errors and improving process efficiency for clinic staff. Specifically, it will involve redesigning the hepatitis B vaccine product order option fields in the EHR to achieve standardization in how the product options are named. This issue cannot be resolved by simply editing the text in the order option fields of the EHR for the clinic, because vaccination product naming is determined at the enterprise level for the organization.

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The project will seek to improve the following measures:

1. The frequency of hepatitis B vaccine administration error per adverse events (e.g., wrong product/series). The frequency is currently 2.5 per month (1.25%). The goal is to reduce this to 1 per month (0.5%), a 60% reduction. This metric will be calculated by dividing reported vaccination errors by the number of hepatitis B vaccines administered to adult patients monthly.

2. Adverse event cost due to administration mistakes. The current cost is $60,000 per year, and the goal is to reduce this to $36,000 per year, a decrease of 40%. This will be tracked monthly by tracking the financial impact of documented administration mistakes based on data in the clinic's financial reporting system. The cost will be determined as the sum of all costs incurred by adverse events, such as additional therapy, personnel time, and other costs over 12 months.

3. Staff satisfaction with the hepatitis B vaccination process, such as ordering providers, nurses, pharmacists, and schedulers. There is no baseline. The goal is 80% satisfaction. This will be measured with a one-question survey on a 5-point Likert scale (1 = very dissatisfied; 5 = very satisfied) that will be distributed one week, one month, and six months after implementation.

4. Adult clinic patient vaccination adherence rate. Adherence is 30% and the target is 50%, an improvement of 67%. Adherence will be reported as the proportion of adult clinic patients who completed the hepatitis B vaccine series.

5. The percentage of EHR override events during the hepatitis B vaccination process. The current rate is 2.5 overrides per month (1.25%). The goal is to reduce this to 1 override per month (0.5%), a 60% decrease. This will be calculated using data from EHR override event reports.

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1. Describe the problem and process to be redesigned.

2. Assemble the team.

3. Map and assess the current state workflow to identify opportunities for improvement.

4. Identify metrics that will be used to measure project outcomes; collect and evaluate baseline data.

5. Identify gaps and map the future state workflow.

6. Design and build the new field in the EHR with input from users.

7. Test the new workflow with EHR field redesign in a playground setting and with end-users.

8. Provide training, first to superuser and then to all users.

9. Go live with the new workflow and process using a big bang approach during a weekend night.

10. Evaluate change using pre-established metrics; refine as needed.

11. Provide support and maintenance for change (in-person and remote)

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Vaccination errors are preventable events that may cause or lead to patient harm, cost inconvenience, and reduced confidence in the healthcare delivery system (CDC, 2021). The cost of a vaccine error in the year 2022 in the United States cost a single outpatient facility an average of $313 per patient or up to $60,000 total in costs per year (Haney, 2023).Correcting vaccination errors is critical to the business side of healthcare to maintain or increase patient retention, trust, and satisfaction while positively influencing patient outcomes and compliance (Eisenberg, 2020).

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Benefit to Internal and External Customers

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Benefit to Internal and External Customers

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Internal customers, or the healthcare facility, benefit from this project by decreasing the amount of money spent on adverse events, maintaining or increasing patient trust, and providing quality care. External customers, or the patients, benefit from this project by receiving trustworthy quality care, having better health outcomes, and having reduced risks of complications from preventable adverse events (World Health Organization, 2023).

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Team members will include:

Group 1 Team

Enterprise Level EHR Support Team

Enterprise Level Informatics Team

Business Analyst

Pharmacist(s)

Staff nurse(s)

Provider(s) (MD/DOs; APPs)

Administration/Operation staff (leaders; schedulers)

IT staff

Nurse informaticist

EPIC liaison

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Week 1: Project start

Week 3: Project charter approved

Week 4: Current state workflow map completed

Week 5: Future state workflow map completed

Week 12: Project completed

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Resources: EPIC software; clinic computers; barcode scanners; quick reference guides and charts for end-users; hepatitis B vaccine policy

People: Enterprise Level EHR Support Team; Enterprise Level Informatics Team; Business Analyst; Pharmacist(s); Staff nurse(s); Provider(s) (MD/DOs; APPs); Administration/Operation staff (leaders; schedulers); IT staff; Nurse informaticist; EPIC liaison; Superusers; Charge nurse

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Plan for Testing New Workflows and Processes

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Plan for Testing New Workflows and Processes

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The LEAN approach is the framework the team will be using. Once the new workflow is mapped, the team will review each step in detail. Simulation testing will be conducted to allow the team to test the workflow from start to finish with all staff roles involved (i.e. nurses, providers, pharmacists, and receptionists/schedulers).

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Plan for Training Individuals on the New Workflows and Processes

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Plan for Training Individuals on the New Workflows and Processes

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1. Staff will receive communication about the new workflow and process, including the training and implementation plan, via email.

2. Brief superuser-facilitated training sessions will be held in the computer lab. These sessions will be role-specific with separate sessions held for providers, staff nurses, pharmacy staff, and schedulers. Role-specific quick reference guides, charts, and updated policies for end-users will be created for reference during training. These resources will be posted at workstations and will be available electronically in the organization’s document library at the time of the “Go-Live”.

3. Elbow-to-elbow training will be provided by superusers and charge nurses at the time of the “Go-Live”, continuing as needed until the change is established and end-users demonstrate competence with the new workflow and process.

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The "Go Live" will occur while the clinic is closed to prevent any disruptions in patient care.

A "big bang" approach will be adopted, where all the sections of the re-engineered workflow are rolled out together.

Superusers, IT staff, and nurse informaticists will provide on-site assistance to resolve issues and guide staff during the transition.

Quick reference guides and role-specific information will be provided to staff prior to the "Go-Live", enabling them to get familiar with the new workflows.

After implementation, the project team will track measures closely, gather feedback, and address any problems.

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Plan for Analyzing and Refining the Workflows

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Plan for Analyzing and Refining the Workflows

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The focus of the analysis will be the pre-established project metrics. Data will be collected and cleaned, if needed.

Then, outcome measures will be calculated, compared to baseline measures, and trended over time.

The project team will meet to examine and discuss the project metrics and interprofessional insights weekly for the first month after the "Go-Live" and then monthly through six months post-launch in order to determine if the new workflow and process needs to be refined.

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The hepatitis B vaccine system redesign project was developed to address the inconsistencies in vaccine ordering, administration, and documentation, which have contributed to errors that could potentially result in patient harm.

This initiative aimed to standardize the hepatitis B vaccine naming conventions within the ambulatory clinic and enterprise-wide across the healthcare organization by redesigning vaccine product order option fields in the EHR system.

Key metrics monitoring the system redesign will help ensure that the interventions in vaccine administration safety and efficiency lead to measurable outcomes.

The successful implementation of this project depends on effective user adoption, ongoing education, and specialized training to ensure clinicians, nurses, pharmacists, and administrative staff are proficient in utilizing the enhanced vaccine ordering and documentation features within the EHR systems.

By establishing a standardized, user-friendly, and error-reducing vaccine administration system, this project aligns with the healthcare organization’s goal of establishing a safer and more efficient immunization process to improve hepatitis B vaccination rates, reduce errors, minimize cost, and enhance patient care outcomes.

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Group 1 Padlet Presentation Reference List